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1 1 (December 22, 2023)

handle is hein.crs/govenur0001 and id is 1 raw text is: Congressional ______ Research Service En Banc Fourth Circuit Weighs Medicaid and State Health Plan Coverage of Certain Medical Care for Transgender Individuals December 22, 2023 States have recently considered the extent to which transgender individuals should have access to certain medical treatments to address a discordance between a person's sex characteristics and gender identity. While some states have enacted legislation ensuring that such services are available to transgender people, other states have policies restricting access to or otherwise limiting health coverage for them. Some of these restrictions are specific to minors, but others cover adults as well. For example, the West Virginia Medicaid program provides a blanket coverage exclusion for transsexual surgery, and North Carolina's State Health Plan for Teachers and State Employees (NCSHP) categorically excludes coverage for treatments leading to or in connection with sex changes or modifications. The West Virginia Medicaid and NCSHP coverage exclusions, as well as other similar Medicaid and state health insurance coverage policies, have been challenged in federal court on the basis that the exclusions constitute sex discrimination in violation of the Fourteenth Amendment's Equal Protection Clause and Section 1557 of the Patient Protection and Affordable Care Act (ACA), among other claims. District and appellate courts across the country considering similar coverage exclusions have arrived at different conclusions, disagreeing about the appropriate level of scrutiny to be applied. For example, a Wisconsin federal district court held that the state health plan's exclusion of coverage for surgery and sex hormones associated with gender reassignment violated the Equal Protection Clause and Section 1557. (The parties agreed to voluntarily dismiss their cross-appeals to the Seventh Circuit.) With respect to Medicaid coverage, the Northern District of Florida held that a state law banning Medicaid reimbursements for sex reassignment prescriptions or procedures, violated the Equal Protection Clause and Section 1557 of the ACA, among other federal laws. The decision was appealed to and is currently pending before the Eleventh Circuit. On the other hand, in denying to preliminarily enjoin enforcement of the state Medicaid program's coverage ban of gender reassignment surgeries for minors, an Arizona district court reasoned, in part, that the plaintiffs had not sufficiently demonstrated that such surgeries were medically necessary, safe, or effective for treating gender dysphoria because the record contained conflicting expert opinions on those issues. The Ninth Circuit affirmed. (The litigation in the Arizona district court was voluntarily dismissed in 2022 prior to any final decision on the merits.) Congressional Research Service https://crsreports.congress.gov LSB11092 CRS Legal Sidebar Prepared for Members and Committees of Congress

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